Advice from the Maternity Clinic Common questions answered

Maternity care providers understand that women and their families have many questions about pregnancy and the time shortly after birth. Some may be reluctant to ask their questions, afraid that they might bother the doctor or nurse with something routine or possibly trivial. Although a question may be common, it is still important that you have an answer. Clinic staff want all of your concerns answered. Ask your questions, regardless of how normal they might seem. Following are examples of questions often asked and the answers to them.

Q1: Is it safe to use sweetener or drink diet pop when I’m pregnant?

Sweeteners have never been studied to see if they are safe in pregnancy, but most have been around for a long time. No problems have been reported, so we believe that most of them are safe in small amounts. As with any kind of junk food, too much is not healthy for anyone!
Sweeteners believed to be safe in small amounts during pregnancy include maltitol, mannitol, sorbitol, lactitol, isomalt, xylitol, acesulfame potassium, aspartame, and sucralose.

Two sweeteners should not be used during pregnancy or breastfeeding, as we do not know if they are safe. These are cyclamates (Sugar Twin® in the yellow box or Sweet’N Low®, and Sucaryl™) and saccharin (Hermesetas™).

Q2: How much vitamin D do I need during pregnancy?

As we learned more about the benefits of vitamin D, the daily recommended intake rose. The current recommended amount of vitamin D for pregnant and breastfeeding women is 2000 international units (IU) per day.

Vitamin D is available in our food. Fish are a source of this vitamin. Three ounces (85 grams) of salmon provides 800 IU, three ounces of mackerel provides 400 IU. In Canada, our milk supply has added vitamin D (100 IU per cup).

More importantly, vitamin D is produced naturally when our skin is exposed to sunlight. Since Canada is a northern country, the sun’s rays are less intense. As well, we spend far fewer hours outside than our ancestors did and so produce less vitamin D. This is a greater concern for Canadians with darker skin tones. Still, all Canadians should take extra vitamin D.

Most prenatal vitamins provide 250 to 400 IU of vitamin D. Vitamin D supplements, in the form of drops or tablets, can be purchased over-the-counter in 400 IU or 1000 IU doses.

Q3: What positions are safe for sleeping during pregnancy?

Lying on the back makes some pregnant women feel faint or dizzy, particularly in the last three months of pregnancy.

Many women have heard the advice to sleep on their left side during pregnancy. However, recent evidence shows that a baby is not affected when the mother lies on her back, even if she has symptoms. The bottom line is you can sleep on either side or your back. If you feel faint or dizzy, change positions to help yourself feel better but do not worry that you have harmed your baby.

Q4: My ankles are swollen. When is this a concern? What can I do about it?

Ankle and calf swelling are very common in pregnancy. This is caused by a combination of many normal changes in the body during pregnancy. Rarely, it can be due to a blood clot deep in the muscles (called deep vein thrombosis or DVT). If one leg is swelling much more than the other or is noticeably painful, call your doctor or midwife right away. This may signal a blood clot.

With the normal swelling of pregnancy, it may help to:

minimize long periods of standing or sitting

elevate your legs from time to time throughout the day

get regular exercise, such as walking or swimming

use compression stockings.

Q5: What is round ligament pain?

The round ligaments, which support the growing uterus during pregnancy, extend from the uterus to the labia. Round ligament pain is sudden, sharp, brief pain in the lower abdomen that spreads to the groin. Sudden movements, such as rolling over in bed, often bring it on. Symptoms often begin in the second trimester and can last until delivery.

Treatment includes rest and changing your position or how you move. Avoid sudden movements. Try supporting your growing uterus with your hands when moving and bend forward at the waist to avoid pain. You might also use Tylenol® and hot compresses.
Alert your physician or midwife if you experience severe pain or cramping of the uterus, pelvic pressure that does not improve with rest, bleeding or spotting, fever or chills, or pain when passing urine.

Q6:What are picket fence pains?

Picket fence pains are brief, sharp, stabbing pains felt in the vagina, often in the third trimester. They are thought to be caused by normal changes of the cervix in preparation for labour. Although they can be annoying, this is a good sign that your body is doing the right things to prepare for a normal birth.
Alert your physician or midwife if you experience severe pain or cramping of the uterus, pelvic pressure that does not improve with rest, bleeding or spotting, fever or chills, or pain when passing urine.

Q7: Is it safe to lift and do physical activity while pregnant?

Every woman and every pregnancy is different. It is not possible to provide specific guidelines on lifting or physical activity in pregnancy.

Some studies have shown a link between physical exertion in pregnancy and preterm delivery. However, the evidence is not conclusive. Repetitive or heavy lifting can cause or worsen muscle and joint symptoms such as low back pain that are common in pregnancy.

Early in your pregnancy, assess the physical demands of your lifestyle and occupation. Change them if necessary. Let your physician or midwife know if you have any difficulties doing so.

Q8: Is it safe to have caffeine during pregnancy?

Beverage

Caffeine Content

Brewed coffee
8 oz/230 mL

135 mg

Starbucks coffee
8 oz/230 mL

250 mg

Starbucks latte
8 oz/230 mL

35 mg

Tea
8 oz/230 mL

35 mg

Dark chocolate
1.5 oz/45 grams

31 mg

Coca-Cola
12 oz/355 mL

46 mg

It is hard for researchers to conduct accurate studies on this topic. Less than 200 milligrams of caffeine per day is a good guideline. More than 200 milligrams of caffeine per day has been shown to reduce babies’ growth by a small amount. To give an idea of what kind of beverages to choose during pregnancy, here are some examples of caffeine content.

Q9: Is it safe to do sit-ups during pregnancy?

Sit-ups or abdominal crunches can be done in the first trimester. After the first trimester they are not recommended for the following reasons.

The rectus abdominis muscles run vertically in the front of the abdomen. As these muscles stretch during pregnancy, sit-ups become less effective.

Sit-ups may increase the chance of these abdominal muscles separating in the centre (called diastasis recti).

Lying on your back may make you feel dizzy or light-headed. (Though this does not pose any danger to you or your baby, it is a reminder to change positions.)

As you progress through the second and third trimesters, switch to different core-strengthening exercises. For instance, you might try planks, seated crunches and pelvic tilts.

Q10: What are the recommendations on eating fish during pregnancy?

Health Canada recommends that pregnant women eat at least 150 grams of fish each week. This is equivalent to a small can of tuna. Fish provides significant amounts of omega-3 fats and other essential nutrients like vitamin D, zinc and iron.

Omega-3 fatty acids transfer across the placenta and play an important role in the growth and development of the baby.

Limit tuna (fresh and frozen), shark, swordfish, marlin, orange roughy and escolar to no more than 150 grams per month due to concerns about methyl mercury ingestion. Also, limit intake of canned (white) albacore tuna to no more than 300 grams per week. However, canned light tuna is low in mercury.

Q11: Are fish oil supplements recommended in pregnancy?

If you do not eat the recommended amount of fish in your diet, fish oil supplements are a source of omega-3 fatty acids. If you choose to take a supplement, look for a Natural Product Number (NPN) on the product label. This shows that the supplement is government-approved for safety, quality and how well it works.

Avoid taking cod liver oil – in combination with a prenatal vitamin you may get a toxic amount of vitamin A.

Q12: Are there restrictions on travel or flying during pregnancy?

Canadian airlines will allow you to fly within Canada up to and during your 36th week. Complications in your pregnancy may prevent you from travelling or flying, so it is best to discuss travel plans with your care provider.

If you are travelling out of your community or city, carry a copy of your prenatal record with you. If you are heading outside of Canada, be sure to have adequate travel medical insurance for both you and the baby. Travelling outside of North America requires that you be assessed for risks of infectious diseases at your destination.

Q13: How do I avoid overdoing it when exercising while pregnant?

At one time, exercise recommendations were made based on your heart rate during exercise. This is no longer the best. Instead, use your sense of how hard you are exerting yourself. One way to assess this is with the ‘talk test’. During exercise you should be able to talk easily (low intensity) or in somewhat shorter sentences (moderate intensity). You should not be breathless (high intensity).

As you progress through your pregnancy, you will likely need to modify your workouts to attain the same level of exertion.

Q14: I am having leg cramps. What can I do?

Leg cramps are common in pregnancy. They often happen in the lower legs, in the latter half of pregnancy, and are most common at night.

To prevent cramps, stay well hydrated. Take enough calcium and magnesium, using an over-the-counter supplement if needed. At bedtime, stretch your calf muscles. Stand about a meter from your bed and lean forward until your ankle flexes as far as it will go. You should feel the stretch in the back of your leg.

Avoid stretching with your toes pointed downwards, as this can trigger a cramp. If you do, try stretching your toes and feet upwards. Massage and warmth, such as a shower, bath or hot pack, may also help.

Q15: What happens if I go past my due date?

Remember, the due date is a guess. Really, it marks the middle of the due month rather than the last day of pregnancy. However, if your pregnancy continues well past the due date, it is important to reassure yourself that your baby is doing well. Counting the baby’s movements at least once a day is one way to check on the baby’s well-being. Most care providers will do an ultrasound if you go a week past your due date, and offer to induce (start) labour eight to ten days past the due date.

Q16: In the newborn period, what is ‘demand feeding’?

Demand feeding means to start feedings based on your baby’s hunger cues, rather than the time since the last feeding.

Babies’ feeding patterns vary greatly, and can be as often as every hour. In the first few weeks of life the average frequency of breastfeeding is eight to 12 times per day.

You will find it is easier to start nursing your baby once you can recognize his early hunger cues. Your baby will move his hands toward his mouth, suck on his fists and finger, repeatedly open and close his mouth, and smack his lips.

By the time your baby is fussy, agitated, flailing his arms and legs or crying loud and persistently, it is harder to begin feeding him.

Q17: In the newborn period, what should I expect in the baby’s diapers?

The amount that your baby pees will show whether she is well-hydrated. Be reassured if your baby is peeing at least as many times as she is days old. That is, she should pee once in her first day of life, three times on her third day, and so on until she is six days old. After that point, the average is six to eight pees a day.

Babies that are successfully feeding will finish passing meconium stools (the first black and tarry poop) and transition to newborn stools within three days of birth. Typically, poop is then pale yellow and looks seedy.

Most infants pass at least three stools per day, often associated with feedings. However, this varies greatly. Formula-fed babies tend to have far fewer stools that are often pasty and more difficult to pass.

These are just a few of the many questions about pregnancy. You may have others. Feel free to discuss any concerns with your care provider. If you do not, you may miss out on some helpful advice.